Healthcare Provider Details

I. General information

NPI: 1598852923
Provider Name (Legal Business Name): ALFRED MARQUEZ CATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE. 212
SANTA ANA CA
92701-4519
US

IV. Provider business mailing address

1845 S FOREST AVE
SANTA ANA CA
92704-4208
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-2125
  • Fax: 714-834-2125
Mailing address:
  • Phone: 714-479-0120
  • Fax: 714-479-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: